Healthcare Provider Details

I. General information

NPI: 1932421583
Provider Name (Legal Business Name): BUURMAN MEDICAL ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 IRVIN COBB DR
PADUCAH KY
42003-0337
US

IV. Provider business mailing address

PO BOX 3537
PADUCAH KY
42002-3537
US

V. Phone/Fax

Practice location:
  • Phone: 270-443-4357
  • Fax: 270-443-2800
Mailing address:
  • Phone: 270-443-4357
  • Fax: 270-443-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28587
License Number StateKY

VIII. Authorized Official

Name: DR. RICHARD MATTHEW BUURMAN
Title or Position: OWNER
Credential: M.D.
Phone: 270-443-4357